Project Summary/Abstract Adult-onset hearing loss is a public health problem due to its very high prevalence in older adults and its impact on them, their family and friends. The needs of these people are often under-recognized and given a low priority by policy makers, funders, primary care providers and families. This has been attributed to the lack of success of hearing healthcare (HHC) in reaching those who can benefit, whether through lack of appropriate awareness of the range of HHC that can meet their needs, fear of the stigma associated with hearing aids, or lack of resources. Therefore there is a need to understand the barriers and facilitators that exist to earlier help-seeking, wider participation and effective support for hearing loss in this older population. This understanding will help us in building and validating a values-based model for choices that people with hearing loss have. This proposal will meet this major research need through the development of a survey instrument (adapted to fit local healthcare policy) to be used in four countries with different HHC policies, using the same research design. The survey will aim to examine the impact of organization, financing and management of health care services on the delivery, quality, cost, access to and outcomes of such services. A secondary aim is to explore the acceptability, benefits and costs of non-technical support for people with hearing loss in the over 60s population. The proposed aims are expected to lead to better health care access and outcomes and direct us to solutions that are effective, affordable and deliverable to those who need them.